Table 1.

Recommendations to Help Promote Equitable LDCT Screening Utilization

Recommendation	Rationale
Require race/ethnicity collection in national LCSR	•  Patient race/ethnicity is not required in the national LCSR,5 making it challenging to track racial disparities in LDCT screening. •  Race/ethnicity information can aid organizations in efforts to monitor potential LDCT disparities and take action as necessary.
Uniformly collect patient pack-year smoking history	•  Patient pack-year smoking history data are not routinely collected in EHRs, which prevents reliable assessment of disparities in LDCT access and utilization.9,10 •  Information on patient pack-year smoking history should be routinely assessed during clinic visits and documented in the EHR.
Fund research to ensure that LDCT eligibility criteria equitably identify high-risk patients	•  Evidence suggests that Black patients (especially men) have higher lung cancer rates than White patients despite their lower mean pack-year tobacco exposure.11,12 •  As LDCT eligibility criteria apply broadly to patients of all races/ethnicities and rely heavily on pack-year smoking history, these criteria may exclude Black patients who have smoked for fewer than 30 pack-years but remain at considerable lung cancer risk. •  Future research is needed to confirm whether existing LDCT eligibility criteria equitably identify high-risk patients and to inform decisions about whether these criteria should be revised (e.g., to rely on risk prediction models or on revised smoking history requirements).
Incorporate Best Practice Advisory alerts into EHRs to prompt providers to assess eligibility	•  Best Practice Advisory alerts can be used in EHRs to remind physicians to discuss screening options with eligible patients for various cancer types (e.g., colorectal).15 •  A similar reminder could help providers target LDCT-eligible patients.
Enhance outreach to referring providers	•  Evidence suggests that some primary care providers may not be aware of lung cancer screening guidelines and thus may not recommend screening to eligible patients.16,17 •  Other physicians may not recommend LDCT due to concerns about potential harms (e.g., from the procedure’s high false positive rate).16,17 •  Organizations should track provider- and practice-level LDCT referral patterns and take action (e.g., educational outreach or training about communicating LDCT benefits and harms) if some practices are less likely to refer eligible patients.
Expand provider and patient capacity for LDCT shared decision making	•  CMS requires that physicians engage in shared decision making with patients to help them make an informed screening decision.5 •  Existing lung cancer mortality disparities may worsen if shared decision making disproportionately benefits some groups (e.g., those with higher health literacy). •  Organizations should use existing LDCT shared decision making tools but must also ensure that the tools are appropriate for diverse populations.19 •  Organizations can also explore opportunities to train providers to effectively engage in shared decision making with diverse populations as needed.
Ensure appropriate and equitable patient follow-up	•  Organizations should monitor whether eligible patients receive screening and follow-up care, especially regarding abnormal results as studies for other cancer types report that minority patients may be less likely than Whites to receive appropriate follow-up after an abnormal screening.8 •  Healthcare organizations concerned about costs associated with implementing LDCT screening, especially for uninsured patients, could explore opportunities to solicit grants or partner with other organizations/foundations to help cover screening costs.
Work with local communities to engage diverse populations	•  Local organizations can engage target populations in screening discussions through educational events and information dissemination. •  Partnering with community organizations may allow potentially eligible patients to discuss screening in settings in which they are comfortable and with people they trust.

Abbreviations: CMS, Centers for Medicare and Medicaid Services; EHR, electronic health record; LDCT, low-dose computed tomography; LCSR, Lung Cancer Screening Registry